Isolated vulval splitting--is this normal or pathological?

Vulval splitting may be seen in association with clinically apparent dermatological disease but occasionally occurs in patients presenting with dyspareunia only. These patients usually have normal-looking vulvas on examination, apart from splitting. They are usually diagnosed as vulval vestibulitis. We have biopsied several patients with isolated vulval splitting with surprising results. Between the months of October 2000 and April 2002, 310 new patients were seen in the vulval clinic at Hope Hospital, which is a tertiary referral centre. Among these were nine cases of isolated vulval splitting, eight of which had histological features of dermatological disease on vulval biopsies. There were three cases of lichen planus, three with chronic dermatitis and two with candidiasis.